Provider Demographics
NPI:1598109464
Name:WALTON, KELLY S (RN)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:S
Last Name:WALTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 ARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:SC
Mailing Address - Zip Code:29379-1714
Mailing Address - Country:US
Mailing Address - Phone:864-429-1737
Mailing Address - Fax:864-429-1799
Practice Address - Street 1:901 ARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:SC
Practice Address - Zip Code:29379-1714
Practice Address - Country:US
Practice Address - Phone:864-429-1737
Practice Address - Fax:864-429-1799
Is Sole Proprietor?:No
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC45990163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool